S.B. No. 684
AN ACT
relating to the relationship of certain optometrists, therapeutic
optometrists, and ophthalmologists with certain managed care
plans, including preferred provider plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1301.051(e), Insurance Code, is amended
to read as follows:
(e) An insurer may not withhold a designation to:
(1) a podiatrist described by Section 1301.0521; or
(2) an optometrist, therapeutic optometrist, or
ophthalmologist described by Section 1301.0522.
SECTION 2. Subchapter B, Chapter 1301, Insurance Code, is
amended by adding Section 1301.0522 to read as follows:
Sec. 1301.0522. DESIGNATION OF CERTAIN OPTOMETRISTS,
THERAPEUTIC OPTOMETRISTS, AND OPHTHALMOLOGISTS AS PREFERRED
PROVIDERS. (a) Notwithstanding Section 1301.051, an insurer may
not withhold the designation of preferred provider to an
optometrist or therapeutic optometrist licensed by the Texas
Optometry Board or an ophthalmologist licensed by the Texas Medical
Board who:
(1) joins the professional practice of a contracted
preferred provider;
(2) applies to the insurer for designation as a
preferred provider; and
(3) complies with the terms and conditions of
eligibility to be a preferred provider.
(b) An optometrist, therapeutic optometrist, or
ophthalmologist designated as a preferred provider under this
section must comply with the terms of the preferred provider
contract used by the insurer or the insurer's network provider.
SECTION 3. Subchapter D, Chapter 1451, Insurance Code, is
amended by adding Section 1451.156 to read as follows:
Sec. 1451.156. PROHIBITED CONDUCT. (a) A managed care
plan, as described by Section 1451.152(a), may not directly or
indirectly:
(1) control or attempt to control the professional
judgment, manner of practice, or practice of an optometrist or
therapeutic optometrist;
(2) employ an optometrist or therapeutic optometrist
to provide a vision care product or service as defined by Section
1451.155;
(3) pay an optometrist or therapeutic optometrist for
a service not provided;
(4) restrict or limit an optometrist's or therapeutic
optometrist's choice of sources or suppliers of services or
materials, including optical laboratories used by the optometrist
or therapeutic optometrist to provide services or materials to a
patient; or
(5) require an optometrist or therapeutic optometrist
to disclose a patient's confidential or protected health
information unless the disclosure is authorized by the patient or
permitted without authorization under the Health Insurance
Portability and Accountability Act of 1996 (42 U.S.C. Section 1320d
et seq.) or under Section 602.053.
(b) Subsection (a)(2) does not prohibit a managed care plan
from employing an optometrist or therapeutic optometrist for
utilization review or for operations of the managed care plan.
(c) Subsection (a)(3) does not prohibit the use of
capitation as a method of payment.
(d) Subsection (a)(4) does not restrict or limit a managed
care plan's determination of specific amounts of coverage or
reimbursement for the use of network or out-of-network suppliers or
laboratories.
(e) An optometrist or therapeutic optometrist must disclose
to a patient any business interest the optometrist or therapeutic
optometrist has in an out-of-network supplier or manufacturer to
which the optometrist or therapeutic optometrist refers the
patient.
(f) This section shall be liberally construed to prevent
managed care plans from controlling or attempting to control the
professional judgment, manner of practice, or practice of an
optometrist or therapeutic optometrist.
SECTION 4. (a) Section 1301.0522, Insurance Code, as added
by this Act, applies only to a contract between a preferred provider
and an insurer that is entered into or renewed on or after September
1, 2015. A contract between a preferred provider and an insurer
that is entered into or renewed before September 1, 2015, is
governed by the law as it existed immediately before the effective
date of this Act, and that law is continued in effect for that
purpose.
(b) Section 1451.156, Insurance Code, as added by this Act,
applies only to a contract between a managed care plan issuer and an
optometrist or therapeutic optometrist entered into or renewed, or
a managed care plan delivered, issued for delivery, or renewed, on
or after September 1, 2015. A contract entered into or renewed, or
a plan delivered, issued for delivery, or renewed, before September
1, 2015, is governed by the law as it existed immediately before
that date, and that law is continued in effect for that purpose.
SECTION 5. This Act takes effect September 1, 2015.
______________________________ ______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 684 passed the Senate on
April 30, 2015, by the following vote: Yeas 31, Nays 0;
May 19, 2015, Senate refused to concur in House amendment and
requested appointment of Conference Committee; May 22, 2015, House
granted request of the Senate; May 29, 2015, Senate adopted
Conference Committee Report by the following vote: Yeas 31,
Nays 0.
______________________________
Secretary of the Senate
I hereby certify that S.B. No. 684 passed the House, with
amendment, on May 13, 2015, by the following vote: Yeas 141,
Nays 0, two present not voting; May 22, 2015, House granted request
of the Senate for appointment of Conference Committee;
May 27, 2015, House adopted Conference Committee Report by the
following vote: Yeas 139, Nays 1, two present not voting.
______________________________
Chief Clerk of the House
Approved:
______________________________
Date
______________________________
Governor